This study proposes to utilize high-fidelity in situ medical simulation to assess Rhode Island's community emergency departments'[EDs] ability to perform pediatric resuscitations. The study also aims to develop a simulation-enhanced educational intervention to assist Rhode Island's community EDs and staff members in improving their skills and optimizing the systems required to effectively perform pediatric resuscitations. A portable simulation program, such as this one, could reduce potential medical errors and create a more efficient and safer environment for acutely ill children who seek care in non-children's hospital EDs. This simulation enhanced educational program could be distributed to other locations where similar needs are identified. During the first year of the program, there will be four site visits to each of the nine EDs. During these site visits, data will be collected on equipment, protocols and multidisciplinary ED team performance to identify latent safety hazards and observable errors encountered during the simulated care of acutely ill children. The data collection will be a combination of audiovisual recordings, standardized qualitative interviews, surveys and an equipment/resource checklist. This information will be used to create site-specific needs-based simulation-enhanced educational interventions and cognitive aids to assist with pediatric resuscitation in all community EDs. The simulation- enhanced educational intervention for the non-children's hospital EDs will be aimed at improving knowledge deficits and reducing potential latent hazards identified during the assessment phase of the project. The intervention will include the use of standardized simulated scenarios, brief didactics, resources for medication dosing and cognitive aids for pediatric resuscitations. The cognitive aids will be presented and the educational intervention will be implemented during the second year of the project on site at each community ED. In the third year, members of the research team will return to each community ED to perform post intervention assessments using additional pediatric simulated resuscitations. The data collection process for the post intervention site visits will be similar to the initial site assessments, including review of audiovisual recordings and qualitative interviews. Two blinded reviewers using a pediatric resuscitation assessment tool will review all video data during the final year. Actual patient data will also be collected using a PICU/Pediatric transport database looking for changes in care with pediatric resuscitations performed by Rhode Island community EDs pre and post intervention. PUBLIC HEALTH RELEVANCE: Pediatric emergencies with critical consequences are an infrequent occurrence in community emergency departments, and as with any rare, high acuity event, there is a significantly higher risk of error, failure in medical decision-making and other adverse events. Medical teams in these hospitals get very limited opportunity to practice pediatric resuscitation, but are expected and required to perform at the highest level when a severely ill or injured child comes through their doors. This project proposes to assess the ability of high-fidelity medical simulation to improve the resuscitation of pediatric patients in community emergency departments.